Abstract: FR-PO401

Factors Associated with Rapid CKD Progression in a Special Predialysis Population under Strict Volume Control

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 301 CKD: Risk Factors for Incidence and Progression

Authors

  • Ortega, Olimpia, Hospital Severo Ochoa, Leganes, Spain
  • Ortiz, Milagros, Hospital Severo Ochoa, Leganes, Spain
  • Mon, Carmen, Hospital Severo Ochoa, Leganes, Spain
  • Herrero, Juan Carlos, Hospital Severo Ochoa, Leganes, Spain
  • Baranyi, Zsofia Katalin, Hospital Severo Ochoa, Leganes, Spain
  • Vasquez, Melissa, Hospital Severo Ochoa, Leganes, Spain
  • Navazo, Diego, Hospital Severo Ochoa, Leganes, Spain
  • Camacho, Rosa, Hospital Severo Ochoa, Leganes, Spain
  • Sanchez, Maria, Hospital Severo Ochoa, Leganes, Spain
  • Di Gioia, Cristina, Hospital Severo Ochoa, Leganes, Spain
  • Gallar, Paloma, Hospital Severo Ochoa, Leganes, Spain
  • Oliet, Aniana, Hospital Severo Ochoa, Leganes, Spain
Background

Fluid overload has emerged recently as an independent predictor of chronic kidney disease (CKD) progression among patients with CKD. Fluid overload control has been our priority for many years in our predialysis outpatient unit using a strategy of strict volume control. The aim of this study was to analyse the hydration status achieved in our patient and to evaluate the independent factors associated with rapid CKD progression or the initiation of dialysis in this special population.

Methods

99 patients with CKD stages 4 and 5 were enrolled and followed for 2.9 ± 1.4 years. All patients were under a strict volume control strategy based on clinical criteria. Body composition monitor was used to analyse the hydration status achieved in our patients. Patients were organized in tertiles of percentage annual GFR decline. Univariate and multivariate logistic regression analysis were used to evaluate the independent factors associated with rapid CKD progression (tertil 3, cutoff value>13%). Cox proportional hazard model was used to analyse the independent factors associated with the initiation of dialysis.

Results

Fluid overload in the whole population was 0.17 (-0.4 to 0.98) and median relative hydration status (fluid overload/ECW) was 1.4 % (-2.25 to 5.2%). During the study period 17 patients iniciate dialysis and 3 patients died. Multivariate logistic regression analysis shows that only NT-proBNP levels (OR 1.01; 95% CI 1.00-1.03; p=0.04) and proteinuria (OR 1.60; 95% CI 1.12-2.39; p=0.03) were associated with rapid CKD progression (tertil 3). The independent factors associated with the initiation of dialysis were NT-proBNP (HR 1.00; 95% CI 1.000-1.001; p=0.006), proteinuria (HR 4.4; 95% CI 1.23-16.1; p=0.02) and low plasma albumin (HR 0.002; 95% CI 0.000-0.69; p=0.04). Fluid overload was not associated with rapid CKD progression nor with the start of dialysis.

Conclusion

A practically normohydration status can be achived even in patients with advanced CKD using a strategy of strict volume control. In this setting, NT-proBNP levels, reflecting increased left ventricular filling pressure and not fluid overload by itself, are associated with rapid CKD progression and the initiation of dialysis.